Upper Canada Test – Rural Data

Renfrew County Healthcare Access and Social Inequity Visualization Platform

The objective of this platform is to provide an open-access tool to visualize a number of key social and spatial determinants of health and health access in the largely-rural region of Renfrew County, Ontario, Canada. This is accomplished by presenting several important indicators of social inequity and access to health services and other amenities by geography in the county on a detailed and interactive univariate choropleth. Variables of interest may be selected individually from the drop-down list below to be displayed on the map.

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Group 1: Indicators of Access to Healthcare and Other Amenities

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Description:

This group includes the following indicators:

– Access To Amenities

– Access To Family Physicians

– Access To Mental Health (All)

– Access To Mental Health (Adult)

– Access To Mental Health (Child/Youth)

– Access To Broadband Internet

These indicators were selected to highlight inequities in access to health services and other common amenities (including education, employment, pharmacy and grocery) by travel time in Renfrew County. Access to amenities was disseminated as a single composite indicator of access to education, employment, pharmacy, grocery and health services. Included health services were family physicians and mental health providers. Access to mental health was provided not only to any mental health facility, but also to adult and child/youth facilities individually. Broadband Internet was the final amenity included in this group out of consideration for its potential to enhance access to health services via virtual care.

Tip for navigation of this map:

Hovering over the icon in the upper right corner of the map opens a layers control. With this control, points that fall under different classes of amenities used in the calculation of this indicator may be shown or hidden for reference. Please note that some Family Physician access points are temporarily omitted until geographic points data are available for visualization.

Access To Amenities

Abbreviations:

DB: Dissemination Block – a census geographic area defined as an area outlined on all sides by roads and/or boundaries of standard geographic areas.

DA: Dissemination Area – a census geographic area defined as a small, relatively stable geographic unit composed of one or more adjacent dissemination blocks.

CSD: Census Subdivision – a census geographic area defined as a municipality or its equivalent.

Description:

This complex indicator, presented as an average travel time (population-weighted by DA when presented on the CSD level) is calculated using information derived from the DMTI’s 2018 Enhanced Points of Interest data file, the 2016 Canadian Census of the Population, and original data collection by the Renfrew County Access and Inequity Geomapping Group.

Amenities were defined as any of the following:

– Childcare (Extensive list of facilities and locations pulled from 2018 DMTI Enhanced Points Of Interest)

– Education (Extensive list of facilities and locations pulled from 2018 DMTI Enhanced Points Of Interest)

– Employment (Estimated from Daily Commute Time statistics from 2016 Census of the Population)

– Grocery and food (Extensive list of facilities and locations pulled from 2018 DMTI Enhanced Points Of Interest)

– Pharmacy (Extensive list of facilities and locations pulled from 2018 DMTI Enhanced Points Of Interest)

– Health services (Including family physicians and mental health services, pulled from an up-to-date list of facilities and locations collected by Renfrew County Access and Inequity Geomapping Group)

Access to Amenities was calculated according to the following method:

1: Estimate travel time to nearest five of each of Childcare, Education, Grocery and Pharmacy by measuring travel time from the geographic centre of each DB to any facility of each type that falls within 60 minutes of driving time from said point following existing road networks. An unweighted average of these five shortest travel times to each of Childcare, Education, Grocery and Pharmacy for each DB under each DA was used to attain the estimated travel time for each DA. A population-weighted average of these travel times was performed by DA to attain the value on a CSD level.

2: Estimate average commute time for each DA by treating each travel time category collected by the 2016 Canadian Census of the Population (under 15 minutes, 15-29 minutes, 30-44 minutes, 45-59 minutes, 60 minutes and up, assumed 60-120 minutes) as bins (i.e., [0:15), [15:29], [30:44], [45:59], [60:120]) and assigning a number of random numbers falling within each bin corresponding to the population of the DA under investigation. The average of these numbers was tabulated and treated as an estimate of commute time for the DA under investigation. The assignment of random times assumed normality within the bins. The same calculation was performed using CSD-level responses from the 2016 Census to attain values on a CSD level.

3: Estimate travel time to family physicians and any mental health facilities, using locations gathered and geocoded by the Renfrew County Access and Inequity Geomapping Group. Trips were routed from the centre of each dissemination block to each provider location, with the travel time value being computed from either the average of the five shortest trips (for family medicine) or the one shortest trip (for mental health) on a dissemination block level, and values being calculated on a CSD level as a population weighted average of the DB level travel times. The DB level and DA level means are unweighted.

4: Average across travel time columns (to each of childcare, education, grocery/food, pharmacy and health services) for each geography. On a DB level, commute time was omitted as the pertinent Canadian Census numbers are not disseminated below the DA level.

References:

DMTI Spatial Inc. Enhanced Points of Interest spatial dataset, Ontario, 2018.

Statistics Canada. 2016. Census of The Population.

Access To Family Physicians

Tip for navigation of this map:

Hovering over the icon in the upper right corner of the map opens a layers control. This permits toggling of provider point visibility. Please note that some Family Physician access points are temporarily omitted until geographic points data are available for visualization.

Abbreviations:

DB: Dissemination Block – a census geographic area defined as an area outlined on all sides by roads and/or boundaries of standard geographic areas.

DA: Dissemination Area – a census geographic area defined as a small, relatively stable geographic unit composed of one or more adjacent dissemination blocks.

CSD: Census Subdivision – a census geographic area defined as a municipality or its equivalent.

Description:

Presented as a population-weighted travel time, access to family physicians was tabulated as the travel time from the geographic centre of each dissemination block to practice locations along road networks as an average of the five shortest trips. A population weighted mean by DA was tabulated to attain the value on a CSD level. An unweighted mean of DB level times is presented on the DA level.

Access to Mental Health (Adult)

Tip for navigation of this map:

Hovering over the icon in the upper right corner of the map opens a layers control. This permits toggling of provider point visibility.

Abbreviations:

DB: Dissemination Block – a census geographic area defined as the area outlined on all sides by roads and/or boundaries of standard geographic areas.

DA: Dissemination Area – a census geographic area defined as a small, relatively stable geographic unit composed of one or more adjacent dissemination blocks.

CSD: Census Subdivision – a census geographic area defined as a municipality or its equivalent.

Description:

Presented as a population-weighted travel time, access to any mental health provider was tabulated as the travel time from the geographic centre of each dissemination block to practice locations along road networks as the time taken for the shortest trip. A population weighted mean using the Census-derived population aged 20 or over of the dissemination block was tabulated to attain the value on a CSD level. An unweighted mean of DB level times is presented on the DA level.

Access to Mental Health (Child/Youth)

Tip for navigation of this map:

Hovering over the icon in the upper right corner of the map opens a layers control. This permits toggling of visibility of provider points. Some Family Physician access points are temporarily omitted until geographic points data are fully encoded for visualization.

Abbreviations:

DB: Dissemination Block – a census geographic area defined as the area outlined on all sides by roads and/or boundaries of standard geographic areas.

DA: Dissemination Area – a census geographic area defined as a small, relatively stable geographic unit composed of one or more adjacent dissemination blocks.

CSD: Census Subdivision – a census geographic area defined as a municipality or its equivalent.

Description:

Presented as a population-weighted travel time, access to any mental health provider was tabulated as the travel time from the geographic centre of each dissemination block to practice locations along road networks as the time taken for the shortest trip. A population weighted mean using the Census-derived population aged 19 or under of the dissemination block was tabulated to attain the value on a CSD level. An unweighted mean of DB level times is presented on the DA level.

Access to Broadband Internet

Abbreviations:

PHH: Pseudohousehold – a geospatially modedled representative distribution of demographic data (population and households) derived from Canadian Census data and provided as points by Statistics Canada.

DA: Dissemination Area – a census geographic area defined as a small, relatively stable geographic unit composed of one or more adjacent dissemination blocks.

CSD: Census Subdivision – a census geographic area defined as a municipality or its equivalent.

Description:

Disseminated according to a speed-delineated scale, broadband Internet access was included as a proxy for access to virtual care, which may enhance access to some health services in regions where travel time is a barrier. Because this indicator was intended to be viewed in light of access to virtual care, beneath the listed speed is a statement of the approximate highest level of virtual care provision possible for each geography, ranging from none up to synchronous/live-interactive. The level approximated for each geography was determined from Figure 1 of “Telehealth and ubiquitous computing for bandwidth-constrained rural and remote areas” by Steele and Lo (2013). Minimum threshold speeds for provision of each denoted type of virtual care (exhaustively, “none”, “asynchronous/store-and-forward”, “low-resolution video-based real time (live interactive)”, and “video-based real time (live interactive)”) was taken as the middle of the range for each respective approximated threshold in the figure. It was assumed that maximum thresholds for speed below 0.092_0.0184 Mbps (dowload_upload) was not sufficient for any means of Internet-requiring virtual care provision. For maximum threshold broadband speeds between 0.092_0.0184 Mbps (dowload_upload) and 0.512_0.1024 Mbps (dowload_upload), it was stated that asynchronous (store-and-forward) delivery was possible. For maximum threshold speeds between 0.512_0.1024 Mbps (dowload_upload) and 10_1 Mbps (dowload_upload), low-resolution video-based synchronous (live-interactive) delivery was presumed possible. For threshold speeds above 10_1 Mbps (dowload_upload), high-resolution video-based synchronous (live-interactive) delivery was presumed possible. Speed data was attained directly from Canadian National Boradband data on a PHH level (Statistics Canada, 2016).

References:

Steele, R, A Lo. Telehalth and Ubiquitous Computing for Bandwidth-Constrained Rural and Remote Areas. Pers Ubiquit Comput. 2013;17:533-43.

Statistics Canada. National Broadband Data. Record ID: 00a331db-121b-445d-b119-35-dbbe3eedd9.

Group 2: Indicators of Income and Deprivation

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Description:

This group includes the following indicators:

– Proportion of Population in Lowest Three Deciles of Income

– Composite Index of Multiple Deprivation

– Index of Multiple Deprivation Residential Instability Domain

– Index of Multiple Deprivation Economic Dependency Domain

– Index of Multiple Deprivation Ethnocultural Composition Domain

– Index of Multiple Deprivation Situational Vulnerability Domain

These indicators were selected to provide the most succinct picture of general social inequity in Renfrew County. The proportion of individuals in the lowest three deciles of income is displayed as a simple indicator of low income. The other indicators were attained or calculated from the Canadian Index of Multiple Deprivation, which was devised by a large group of stakeholders to offer a succinct yet valuable insight into social deprivation by geography. It must be noted that while this index and its four domains are tabulated from of a number of carefully selected Census-derived indicators, a key limitation to their use in this map is that the indicators are not rural-specific. Indeed, while it promotes facile visualization, the act of distilling an image of social inequity down to a number is in itself limited in comprehensiveness.

Proportion of Population in Lowest Three Deciles of Income

Abbreviations:

DA: Dissemination Area – a census geographic area defined as a small, relatively stable geographic unit composed of one or more adjacent dissemination blocks.

CSD: Census Subdivision – a census geographic area defined as a municipality or its equivalent.

Description:

Tabulated from income decile data drawn from the 2016 Canadian Census of the Population, the proportion of the population in the lowest three deciles of income is calculated by dividing the sum of individuals in each of the lowest three deciles of income by the total number of individuals classified into any of the ten income deciles. This value serves as a rudimentary indicator of low income, which is an important social determinant of (ill) health. Hence, inequities are seen where proportions of individuals in the bottom three deciles of income are high.

References:

Statistics Canada. 2016. Census of The Population.

Composite Indicator of Multiple Deprivation

Abbreviations:

DA: Dissemination Area – a census geographic area defined as a small, relatively stable geographic unit composed of one or more adjacent dissemination blocks.

CSD: Census Subdivision – a census geographic area defined as a municipality or its equivalent.

Description:

This indicator is tabulated (as recommended by the Canadian Index of Multiple Deprivation User Guide) as the mean of the quintile scores for each sub-domain of the Canadian Index of Multiple Deprivation (Residential Instability, Economic Dependency, Ethnocultural Composition, Situational Vulnerability) (Statistics Canada, 2019). These quintile scores were tabulated relative to Renfrew County. This composite indicator is intended to provide a “snapshot” or “summary score” of all domains incorporated into the Canadian Index of Multiple Deprivation for each geographic subset of the county. It is not intended to be viewed a “master indicator” of deprivation or social inequity in an area, given the complex, subjective and multifaceted nature of such a concept. Values for each sub-domain are given on a DA level in the Canadian Index of Multiple Deprivation. To attain the value for this composite indicator on a CSD level, an unweighted mean of DA-level scores is provided. Population weighting was avoided to mitigate urban-centric bias in the presentation of social inequity in larger geographies on this choropleth.

References:

Statistics Canada. 2019. “The Canadian Index of Multiple Deprivation”. Statistics Canada Catalogue no. 45-20-0001.

Index of Multiple Deprivation Residential Instability Domain

Description:

This indicator is attained from the Canadian Index of Multiple Deprivation on a DA level (Statistics Canada, 2019). The provided score is a quintile tabulated relative to Renfrew County. To attain the value for this indicator on a CSD level, an unweighted mean of DA-level scores is provided. Population weighting was avoided to mitigate urban-centric bias in the presentation of social inequity in larger geographies on this choropleth. The Residential Instability Domain of the Canadian Index of Multiple Deprivation accounts for the following:

– The proportion of dwellings that are apartment buildings

– The proportion of dwellings that are owned (reverse-coded)

– The proportion of individuals living alone

– The proportion of the population that moved within the past five years

– The proportion of the population that is married or living common-law (reverse-coded)

References:

Statistics Canada. 2019. “The Canadian Index of Multiple Deprivation”. Statistics Canada Catalogue no. 45-20-0001.

Index of Multiple Deprivation Economic Dependency Domain

Description:

This indicator is attained from the Canadian Index of Multiple Deprivation on a DA level (Statistics Canada, 2019). The provided score is a quintile tabulated relative to Renfrew County. To attain the value for this indicator on a CSD level, an unweighted mean of DA-level scores is provided. Population weighting was avoided to mitigate urban-centric bias in the presentation of social inequity in larger geographies on this choropleth. The Economic Dependency Domain of the Canadian Index of Multiple Deprivation accounts for the following:

– The proportion of individuals aged 65 or over

– The proportion of the population 15 years and over that participates in the labour force (reverse-coded)

– The ratio of employment to population (reverse-coded)

– The dependency ratio

– The proportion of the population receiving government transfer credits

References:

Statistics Canada. 2019. “The Canadian Index of Multiple Deprivation”. Statistics Canada Catalogue no. 45-20-0001.

Index of Multiple Deprivation Ethnocultural Composition Domain

Description:

This indicator is attained from the Canadian Index of Multiple Deprivation on a DA level (Statistics Canada, 2019). The provided score is a quintile tabulated relative to Renfrew County. To attain the value for this indicator on a CSD level, an unweighted mean of DA-level scores is provided. Population weighting was avoided to mitigate urban-centric bias in the presentation of social inequity in larger geographies on this choropleth. The Ethnocultural Composition Domain of the Canadian Index of Multiple Deprivation accounts for the following:

– The proportion of the population that is foreign-born

– The proportion of the population that self-identify as a visible minority

– The proportion of the population without any knowledge of any official language (i.e. “linguistic isolation”)

– The proportion of the population that is composed of individuals who immigrated within the past 5 years

References:

Statistics Canada. 2019. “The Canadian Index of Multiple Deprivation”. Statistics Canada Catalogue no. 45-20-0001.

Index of Multiple Deprivation Situational Vulnerability Domain

Description:

This indicator is attained from the Canadian Index of Multiple Deprivation on a DA level (Statistics Canada, 2019). The provided score is a quintile tabulated relative to Renfrew County. To attain the value for this indicator on a CSD level, an unweighted mean of DA-level scores is provided. Population weighting was avoided to mitigate urban-centric bias in the presentation of social inequity in larger geographies on this choropleth. The Situational Vulnerability Domain of the Canadian Index of Multiple Deprivation accounts for the following:

– The proportion of the population that identifies as Indigenous

– The proportion of the population aged 25-64 without a high school diploma

– The proportion of dwellings in need of major repairs

References:

Statistics Canada. 2019. “The Canadian Index of Multiple Deprivation”. Statistics Canada Catalogue no. 45-20-0001.

Group 3: Population Characteristics

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Description:

This group includes the following indicators:

– Population Density

– Proportion Of Population Educated Below Post-Secondary Degree

– English to All Official Language Ratio

– Official Language to All Language Ratio

– Dependency Ratio

– Proportion of Population 19 Years Of Age or Under

– Proportion of Population 65 Years Of Age or Over

– Employment Characteristics

These indicators are either calculated or drawn from the 2016 Census of the Population and were selected to provide a concise snapshot of several key population characteristics to contextualize and supplement the presentation of social inequity and access to health services and other amenities in Renfrew County.

Population density

Description:

Drawn directly from the 2016 Canadian Census of the Population, this indicator is presented as the population density of the denoted geography level as a number of individuals per square kilometre. This serves as a rudimentary indicator of rurality.

References:

Statistics Canada. 2016. Census of The Population.

Proportion Of Population Educated Below Post-Secondary Degree

Description:

This indicator, calculated from 2016 Canadian Census of the Population data, was tabulated as the sum tally of individuals whose highest level of education is below the level of a high-school degree and that of individuals whose highest level of education is at the level of a high-school degree divided by the sum of all responses in the geography of interest, with this calculation repeated across geographies.

References:

Statistics Canada. 2016. Census of the Population.

Ratio of English to All Official Languages

Description:

Derived from 2016 Canadian Census vectors related to the languages spoken most frequently by the respondent, this indicator was tabulated as the sum of all responses that contained English (alone or in combination with another response) divided by the sum of all responses that contained an official language (i.e. English and/or French, alone or in any combination). Considering the importance of effective patient-to-provider communication in the provision of health services, this serves as an indicator of access to health services by language, since some facilities may offer services in only one official language, which, in Renfrew County, is more often English than French. Language may also limit access to other amenities.

References:

Statistics Canada. 2016. Census of The Population.

Official Language to All Language Ratio

Description:

Derived from 2016 Canadian Census vectors related to the languages spoken most frequently by the respondent, this indicator was tabulated as the sum of all responses that contained an official language (i.e. English and/or French, alone or in any combination) divided by the sum of all responses to the question. Considering the importance of effective patient-to-provider communication in the provision of health services, this serves as an indicator of access to health services by language, seeing as most facilities are not equipped to offer service outside of the official languages. Access to other amenities may also be limited by language. The opposite indicator (the proportion of the population with no knowledge of any official language, also called “linguistic isolation”) is a component of the Canadian Index of Multiple Deprivation (CIMD)’s Ethnocultural Composition domain, with higher levels of linguistic isolation being indicative of an ethnocultural composition that may indicate social inequity (Statistics Canada, 2019).

References:

Statistics Canada. 2016. Census of The Population.

Statistics Canada. 2019. “The Canadian Index of Multiple Deprivation”. Statistics Canada Catalogue no. 45-20-0001.

Dependency Ratio

Description:

Tabulated from age data drawn from the 2016 Canadian Census of the Population, the dependency ratio is calculated as the sum of individuals aged 19 or under and 65 or over divided by the sum of individuals between the ages of 20-64 inclusive all multiplied by 100. Under this ratio, it is assumed that individuals under the age of 20 or over the age of 64 are “dependents” and those aged 20-64 are “independents” such that the ratio is given as the number of “dependents” per 100 “independents”. This indicator is a component of the Canadian Index of Multiple Deprivation (CIMD)’s Economic Dependency domain (Statistics Canada, 2019). Higher dependency ratios are indicative of a level of economic dependency that might suggest social inequity.

References:

Statistics Canada. 2016. Census of The Population.

Statistics Canada. 2019. “The Canadian Index of Multiple Deprivation”. Statistics Canada Catalogue no. 45-20-0001.

Proportion of Population 19 Years Of Age or Under

Description:

Tabulated from age data drawn from the 2016 Canadian Census of the population, the proportion of the population aged 19 years and under is calculated by dividing the sum total population aged 19 or under by the sum total of the population. Inequities are seen in areas with high proportions of individuals under the age of 19 with low access to youth-specific amenities and medical services.

References:

Statistics Canada. 2016. Census of The Population.

Proportion of Population 65 Years Of Age or Over

Description:

Tabulated from age data drawn from the 2016 Canadian Census of the population, the proportion of the population aged 65 years and over is calculated by dividing the sum total population aged 65 or over by the sum total of the population. Inequities are seen in areas with high proportions of individuals over the age of 65 with long travel times to amenities and medical services since older adults may be particularly susceptible to transportation challenges.

References:

Statistics Canada. 2016. Census of The Population.

Employment Characteristics

Description:

Drawn directly from the 2016 Census of the Population, the employment participation rate is provided on a CSD and a DA level. Also included in the popup is a breakdown of the predominant class of occupation by the Government of Canada’s 10-category scale (by percent employed in that class relative to those employed in any) for each DA and CSD of Renfrew County. Beneath the statement of the predominant class of occupation is a breakdown of the percentage of the employed population of the geography under scrutiny employed in the denoted class. These percentages were tabulated from counts drawn from the 2016 Census of the Population.

References:

Statistics Canada. 2016. Census of The Population.

This project was completed under the guidance of the following partners as the Renfrew County Access and Inequity Geomapping Group:

Dr. J. Fitzsimon

Dr. P. Peters

Dr. C. Belanger

Dr. L. Bjerre